Professional Documents
Culture Documents
Meningitis
Meningitis
Petichial Rash
•Herpesvirus
–HSV-1 and HSV-2, Varicella-zoster virus,
EBV, CMV, HHV*-6, HHV-7
•Paramyxovirus
–Mumps virus, Measles virus
Viruses
•Togavirus
–Rubella virus
•Flavivirus
–Japanese encephalitis virus, St. Louis
encephalitis virus
•Bunyavirus
–California encephalitis virus, La Crosse
encephalitis virus
•Alphavirus
–Eastern equine encephalitis virus,
Western equine encephalitis virus,
Venezuelan encephalitis virus
Viruses
•Reovirus
–Colorado tick fever virus
•Arenavirus
–LCM virus
•Rhabdovirus
–Rabies virus
•Retrovirus
–HIV
Acute viral meningitis:
Viral meningitis comprises most aseptic meningitis
syndromes.
• Enterovirus
– Enterovirus belongs to the family Picornaviridae. It is classified further to
include polioviruses (3 serotypes), coxsackievirus A (23 serotypes),
coxsackievirus B (6 serotypes), echovirus (31 serotypes), and the newly
recognized enterovirus serotypes 68-71.
– They are distributed worldwide, and the infection rates vary depending
on the season of the year and the age and socioeconomic status of the
population.
– The virus is usually spread by fecal-oral or respiratory routes and occurs
during summer and fall in temperate climates and year-round in tropical
regions.
– Most of the infections occur in individuals who are younger than 15
years, with the highest attack rates in children who are younger than 1
year.
– The nonpolio enteroviruses (NPEV) account for approximately 90% of
cases of viral meningitis in which a specific pathogen can be identified.
– In patients with deficient humoral immunity (eg, agammaglobulinemia),
enterovirus meningitis may have a fatal outcome.
• Herpesvirus
– The Herpesviridae family consists of large DNA-containing
enveloped viruses. Eight members are known to cause human
infections, and all have been implicated in meningitis
syndromes, with the exception of HHV-8 or Kaposi sarcoma–
associated virus.
– HSV-1 is a cause of encephalitis, while HSV-2 more commonly
causes meningitis. Although more commonly associated with
HSV-2, both viruses have been implicated to cause Mollaret
syndrome, a recurrent but benign aseptic meningitis syndrome.
– EBV, or HHV-4, and CMV, or HHV-5, may manifest as
meningitis during the mononucleosis syndrome.
– Varicella zoster virus (VZV), or HHV-3, and CMV are causes of
meningitis in immunocompromised hosts, especially patients
with AIDS and transplant recipients.
– HHV-6 and HHV-7 have been reported to cause meningitis in
transplant recipients.
• Arthropod-borne viruses
– The most common arthropod-borne viruses are St.
Louis encephalitis virus (a flavivirus), Colorado tick
fever, and California encephalitis virus (bunyavirus
group, including La Crosse encephalitis virus).
– St. Louis encephalitis virus is a mosquito-borne
flavivirus that may cause a febrile syndrome, aseptic
meningitis syndrome, and encephalitis. The infection
usually occurs during the summer and early fall, with
symptoms typical of acute aseptic meningitis.
– Other members of the flavivirus group that may cause
aseptic meningitis include tick-borne encephalitis
virus and Japanese encephalitis virus.
– California encephalitis is a common childhood
disease of the CNS that is caused by a virus in the
genus Bunyavirus. Most of the cases of California
encephalitis are probably caused by mosquito-borne
La Crosse virus. The infection with symptoms typical
of acute aseptic meningitis.
• Lymphocytic choriomeningitis virus
– LCM virus is a member of the arenaviruses, a family
of single-stranded RNA-containing viruses with
rodents as the animal reservoir.
– The infection occurs worldwide, and most human
cases occur among young adults during autumn.
– The modes of transmission include aerosols and
direct contact with rodents.
– Following exposure, an incubation period of
approximately 5-10 days ensues, followed by a
nonspecific febrile illness and an acute onset of
aseptic meningitis. This may be associated with
orchitis, arthritis, myocarditis, and alopecia.
• Human immunodeficiency virus
– Aseptic meningitis syndrome may be the presenting symptom in
a patient with acute HIV infection. This usually is part of the
mononucleosis like acute sero-conversion phenomenon.
– Always suspect HIV as a cause of aseptic meningitis in a patient
with risk factors such as intravenous drug use and in individuals
who practice high-risk sexual behaviors.
Specific
pathogen
Bacterial 100-5000; demonstrated in
200-300 <40 >100
meningitis >80% PMNs* 60% of Gram
stains and 80%
of cultures
Normal,
Normal but
10-300; reduced in Viral isolation,
Viral meningitis 90-200 may be slightly
lymphocytes LCM and PCR† assays
elevated
mumps
0-5; Negative
Normal values 80-200 50-75 15-40 findings on
lymphocytes workup
• Vaccination
– The use of the HIB vaccination is strongly recommended in
susceptible individuals.
– Vaccination against S pneumoniae is strongly encouraged in
susceptible individuals, including individuals older than 65 years
and those with chronic cardiopulmonary illnesses.
– Vaccinations against encapsulated bacterial organisms (eg, S
pneumoniae, N meningitidis) are encouraged for those with
functional or structural asplenia. Always administer vaccinations
expediently to individuals who undergo splenectomy.
– Offer vaccination with quadrivalent meningococcal
polysaccharide vaccine to all high-risk populations, including
those with underlying immune deficiencies, those who travel to
hyperendemic areas and epidemic areas, and those involved
with laboratory work that deals with routine exposure to N
meningitidis. College students who live in dormitories or
residence halls are at modest risk; inform them about the risk
and offer vaccination.
– Vaccination against N meningitidis is recommended for all
adolescents aged 11-18 years.
– Vaccination against measles and mumps effectively eliminates
aseptic meningitis syndrome caused by these pathogens.